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North Carolina Among the Worst for Children's Dental Health

A new study puts North Carolina in the bottom five of states for school-based dental sealant treatment programs, considered the most effective way to give at-risk children a shot at growing up with healthy teeth.

The pain and social stigma of decaying teeth can be largely eliminated through early use of sealant treatments, but North Carolina children from low-income families may be less likely to receive preventative dental care than their peers across the nation.

A new study puts North Carolina in the bottom five of states for school-based dental sealant treatment programs, considered the most effective way to give at-risk children a shot at growing up with healthy teeth.

"Oral health problems not only can be painful but are linked to lower academic scores and additional physical problems," says Jane Koppelman, senior officer for the Pew Charitable Trusts' Dental Campaign, which conducted the study.

"Sealants are a quick, one-time procedure costing about a third of the cost of filling a molar, the most cavity-prone teeth."

Dental sealants are a type of liquefied plastic that is painted over the uneven chewing surfaces of back teeth to prevent food particles from being trapped and bacteria from forming. A Surgeon General's report on oral health says sealants can reduce decay by 70 percent.

The Pew study shows that 34 percent of children from average-to higher-income households across the nation have had sealant treatments. The number drops to 26 percent in lower-income families. About 27 percent of black children are treated, compared to 36 percent of white children.

A screening of North Carolina fifth graders by the state health department during the 2009-10 school year found 44 percent had sealants on one or more teeth, said Rebecca King, who oversees the Oral Health section at the state Department of Health and Human Services .

"We don't have the resources to provide sealants to all these kids, but we have been educating parents since the mid-1980s and trying to encourage them to take children to their own dentists to get them," King said.

Still, North Carolina earned a grade of "F" in the Pew study because only a quarter of its high-risk schools have on-site programs. Nearly half of all states earned either a "D" or an "F" based on the Pew survey's criteria.

School-based programs are preferred because they are the most effective means of reaching under-served families, said Gary Rozier, a professor of health policy at UNC's Gillings School of Global Public Health who led a Centers for Disease Control work group on dental sealants.

"These programs provide ready access to children whose families can't afford regular dental care, who are unable to locate a dentist in their community, or who simply don't value dental services," Rozier said.

King said North Carolina has a large percentage of schools whose students fall into the high-risk category, and she agreed that preventative dental health services need to be expanded for low-income children in the state. The state provides screenings and some limited dental care to fifth-grade students each year.

During the 2009-10 school year, the most recent year with data available, North Carolina screened more than 80,000 fifth-graders for dental problems. Some were referred for follow-up care to outside agencies, while 11,200 were provided direct care -- including 5,100 sealant applications.

The state's oral health program has a budget of $5.3 million after suffering $1.4 million in cuts since 2009. Three-quarters of the funding comes through state sources, and the remaining 35 percent is from Medicaid.

"Our legislative mandate is to focus on children, and our emphasis is on getting to them early, before they develop extensive problems," King said.

Spin-off benefits of decay prevention include better nutrition and less absenteeism for children and cost savings for parents and public funding agencies that cover dental treatments, such as Medicaid, Rozier said.

A typical sealant application costs about $45, approximately a third of the cost of a filling, according to dentist Amanda Allen, who was busy last week checking and sealing teeth on youngsters at the Wake Health Services Dental Center.

The dental center uses a combination of funding sources to provide services to patients on Medicaid, those who have private insurance, and those who are uninsured.

Marquesa Barden, 32, a medical technologist whose dental insurance coverage does not extend to other family members, said she takes her three children to the Wake dental center for regular check ups.

"The dentist brought up the need for the sealants, and I thought it was a good idea," Barden said. "I don't want my kids to get toothaches. I want them to be able to smile."

Allen said parent education is a big factor in ensuring children get the dental care they need. Some families shy away from dental care due to fear or concerns about cost.

"If we can protect their teeth with sealants, we can prevent cavities, and they can learn better and eat better," Allen said. "And it helps them feel good about themselves."

Dr. Gary Kushner, director of Mecklenburg County Health Department's dental program for children, said the low score for North Carolina is undeserved.

"You can tell a story with statistics," he said, "but I don't think it's a fair assessment of what North Carolina does for its children.It makes us seem like we're just sitting there looking out the window doing nothing."

Since 1996, he said, the proportion of N.C. fifth-graders who have been treated with sealants rose from 28 percent to 44 percent. That was short of the 50 percent goal in the Healthy People 2010 plan, but "I think that's pretty good," Kushner said.

He is one of three dentists at the health department's dental clinic, inside Carolinas Medical Center-Biddle Point on Rozzelles Ferry Road. It's open to anyone age 6 months to 15 years. Most patients are on Medicaid, but there is also a sliding fee scale based on income.

Although there is no school-based sealant program in Mecklenburg, Kushner said four public health dental hygienists go into the schools for screening and education.

Screenings show Mecklenburg, the largest county in the state, has the "lowest percent of untreated dental decay" among kindergarteners in the state, Kushner said. During the 2009-10 school year, 9,450 Mecklenburg kindergarteners -- 88 percent of the total -- were screened, and 9 percent were found to have untreated tooth decay. That compares to 25 percent to 30 percent in other counties, Kushner said.

"That does not mean that there is not a dental decay problem," he said. Part of the problem is that not enough parents are taught how to take care of their young children's teeth.

"When you don't drive the toothbrush the right way, you're going to leave plaque on teeth," Kushner said. "Parents haven't been shown."

Kushner said he recently saw an 18-month-old child whose four front teeth had to be removed and a 2-year-old who had about 8 teeth removed and also needed several silver caps and baby root canals.

Among the reasons small children have tooth decay: Too much snacking, drinking juice and other sweet drinks at bed time, and drinking bottled water instead of fluoridated water from the tap. Parents also don't realize, Kushner said, that children should see a dentist for the first time around their first birthdays -- "You want to get it before bad things happen."

The health department isn't the only source of dental care for low-income patients. Community Care Partners of Greater Mecklenburg, the local Medicaid agency, has a list of about 40 Mecklenburg dental clinics that accept Medicaid. It also oversees a program called "Into the Mouths of Babes," that helps pediatricians and family physicians provide "dental varnishing," or fluoride treatments brushed on teeth, for children up to 3 years old.

Dr. Will Summerville, who accepts Medicaid patients at his office on Wendover Road, said he typically recommends sealants for children when their first molars come in, around age 6. Children reaching puberty may also be good candidates because they may not be conscientious about routine dental care.

He said he wouldn't necessarily suggest sealants for a teen who demonstrates good oral hygiene and has no history of cavities.